Senior Business Analyst - Provider+

About the role

As a Senior Business Analyst - Provider+ at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

Summary

Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Requirements & Design

• Serves as the primary Domain SME and trusted advisor to the Engagement Lead (EL) on business processes, including regulatory and operational impacts.
• Ensures solutions align with CMS guidance, state policy, and documented business rules.
• Supports the EL with scope negotiations and change control by assessing trade-offs and evaluating functional, regulatory, and operational impacts of requested changes.
• Leads and participates in requirements and design sessions with clients and internal teams to validate functional and technical needs.
• Interprets federal and state Medicaid policies and translates them into system configuration, product features, business rules, and design artifacts.
• Acts as a policy SME supporting the Domain Lead with analysis, interpretation, and solution recommendations.
• Develops and maintains domain design documentation, including a comprehensive Design Document covering workflows, interfaces, X12 EDI transactions, letters, and reports.
• Ensures requirements are accurate, complete, and traceable, with clearly defined acceptance criteria.
• Documents domain-level decisions, assumptions, risks, and dependencies, evaluating downstream impacts.

Build / Configuration

• Supports configuration and implementation activities across Design, Development, and Implementation (DDI).
• PARTNERS WITH TECHNICAL TEAMS TO ENSURE SOLUTIONS ALIGN WITH APPROVED DESIGNS, POLICY INTERPRETATIONS, AND BUSINESS RULES.
• RESPONSIBLE FOR DOMAIN-SPECIFIC CONFIGURATION, INCLUDING:
• - CLAIMS: EDITS, PRICING, BENEFIT LIMITS, ADJUDICATION LOGIC
• - PLAN: CONTRACTS, BENEFITS, PROGRAMS, FEE SCHEDULES
• - PROVIDER: TYPES, SPECIALTIES, CONTRACTS, ENROLLMENT, CREDENTIALING
• - MEMBER: ELIGIBILITY, BENEFITS, PLANS, DEMOGRAPHICS
• - PHARMACY: RX BENEFITS AND CLAIM PROCESSING

Testing

• Reviews test cases to ensure alignment with requirements, policies, and acceptance criteria.
• Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Aids in defect analysis, root cause investigation, resolution validation, retesting, and ensuring overall functional readiness.

Operational Readiness & Deployment

• SUPPORTS OPERATIONAL READINESS ACROSS ENVIRONMENTS, DATA, PROCESSES, AND STAFFING.
• PROVIDES DOMAIN EXPERTISE FOR OPERATIONAL READINESS REVIEWS (ORR), PARALLEL TESTING, AND PERFORMANCE TESTING.
• CONTRIBUTES TO CUTOVER PLANNING, TRANSITION TO OPERATIONS, AND HYPERCARE SUPPORT.

Collaboration & Client Engagement

• PARTNERS CLOSER WITH DOMAIN LEADS AND TECHNICAL ANALYSTS AS A KEY DOMAIN AND POLICY SME.
• LEADS AND SUPPORTS CLIENT COMMUNICATIONS, INCLUDING REQUIREMENTS DISCUSSIONS, DESIGN REVIEWS, AND ISSUE RESOLUTION.
• FACTORIALS WORKING SESSIONS ACROSS BUSINESS, CONFIGURATION, AND TECHNICAL TEAMS.
• DELIVERS FUNCTIONAL DEMOS AND SOLUTION WALKTHROUGHS TO VALIDATE PRODUCT ALIGNMENT WITH CLIENT NEEDS.
• SUPPORTS DOCUMENTATION, KNOWLEDGE TRANSFER, AND ONGOING OPERATIONAL SUPPORT.

Qualifications

• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field.
• 5 to 8 years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
• Experience with QNXT or similar healthcare claims/encounter management systems.
• Strong knowledge of state and federal Medicaid policy, regulations, and program rules (required).
• Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes.
• Demonstrated experience translating policy and program rules into system requirements, configuration support, and design artifacts.
• Strong knowledge of SQL is required, particularly for data analysis and validation.
• Strong client communication skills, with experience interacting directly with business stakeholders.
• Proven ability to lead or support functional demonstrations, walkthroughs, and collaborative working sessions.
• Strong documentation, facilitation, and analytical skills.
• Experience working in SDLC and Agile delivery environments.

Skills

• Knowledge of MITA (Medicaid Information Technology Architecture).
• Experience with system integrations, EDI/X12 transactions, analytics, and reporting.
• Familiarity with state and federal healthcare regulations and compliance standards.

Benefits

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.”